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This phase I trial studies the best dose of radiation therapy in treating patients with locally advanced non-small cell lung cancer that cannot be removed by surgery. Radiation therapy uses high energy x rays to kill tumor cells. Specialized radiation therapy, such as stereotactic body radiation therapy (SBRT), that delivers a high dose of radiation directly to the tumor may kill more tumor cells and cause less damage to normal tissue. SBRT has been shown to provide excellent results when used in early stage lung cancer, but has not yet been applied to patients with more advanced disease.

To test the safety and tolerability of an alternative fractionation regimen in locally advanced non-small cell lung cancer (NSCLC), consisting of 44 Gy with concurrent chemotherapy followed by a stereotactic body radiation therapy (SBRT) boost to remaining parenchymal and nodal disease. The maximum tolerated dose of the SBRT boost will be determined.

SECONDARY OBJECTIVES:

To assess local control.

To assess distant metastasis and patterns of failure.

To assess overall survival at 1 and 2 years.

OUTLINE: This is a dose-escalation study of radiation therapy and SBRT.

Maximum tolerated dose (MTD) defined to be the dose level that results in a probability equal to 0.33 that a dose limiting toxicity (DLT) will be manifest using Common Terminology Criteria for Adverse Events (CTCAE) version 4 (v.4) [ Time Frame: Up to 1 year ]

Acute toxicities associated with this regimen using CTCAE v.4 [ Time Frame: Up to 90 days ]

Crude rates of grade 3 and greater acute toxicities will be reported.

Late toxicities associated with this regimen using CTCAE v.4 [ Time Frame: After 90 days ]

Crude rates of grade 3 and greater late toxicities will be reported.

Secondary Outcome Measures
:

Local control [ Time Frame: Up to 5 years ]

Will be calculated for the entire cohort using Kaplan-Meier methodology.

Distant metastasis [ Time Frame: Up to 5 years ]

Will be calculated for the entire cohort using Kaplan-Meier methodology.

Patterns of failure [ Time Frame: Up to 5 years ]

Will be assessed with standard follow-up imaging, and the percentages of in-field failures versus regional nodal failures calculated.

Overall survival [ Time Frame: At 1 year ]

Will be calculated for the entire cohort using Kaplan-Meier methodology.

Overall survival [ Time Frame: At 2 years ]

Will be calculated for the entire cohort using Kaplan-Meier methodology.

Overall survival [ Time Frame: At 5 years ]

Will be calculated for the entire cohort using Kaplan-Meier methodology.

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If the primary tumor is central in location, defined as within 2 cm from the tracheobronchial tree, it must be no larger than 5 cm

Mediastinal and hilar lymphadenopathy can be no larger than 5 cm at any nodal station

Pretreatment brain CT with contrast or brain MRI to rule out metastases

Pathologic assessment of the mediastinum to document involved nodal stations

All of the above inclusion criteria must occur within 8 weeks prior to patient registration, with the exception of pathologic assessment of the mediastinum and biopsy to confirm NSCLC, which can be done within 12 weeks of patient registration